What is Post-Partum Thyroiditis (PPT)?
Post-partum thyroiditis (PPT) is a common condition that can cause both hypothyroidism (low thyroid hormones) and hyperthyroidism (high thyroid hormones). PPT typically occurs within the first few months after birth but can develop within the first year.
Why Does PPT Happen?
During pregnancy, the immune system is suppressed. After pregnancy, as the immune system recovers, autoimmune and inflammatory conditions can flare up. PPT is caused by inflammation of the thyroid, which results in the release of pre-formed hormones. Due to this inflammation and damage, the thyroid may initially release high levels of hormones, followed by a phase of low hormone levels as it recovers. Some individuals may experience only the high or low hormone phase.
Recognizing Symptoms
Symptoms of low or high thyroid hormones are often mistaken for normal post-partum symptoms, such as tiredness, low mood, anxiety, brain fog, and weight changes. Other symptoms can include a racing heart, tremors, feeling hot or cold, changes in bowel habits, and poor milk production.
When to Test for PPT
Thyroid testing is not routinely done at the six-week post-partum check-up but should be considered if someone has symptoms or is at high risk for PPT. In the general population, the incidence of PPT is around 5-10%. For people with type 1 diabetes, the incidence is 25%, and for those with thyroid antibodies or who required thyroxine during pregnancy, the incidence can be as high as 50%.
Managing PPT
For many people, PPT will have no symptoms or mild symptoms that resolve on their own. For very high hormone levels, treatment with prednisolone and a medication to decrease heart rate (beta-blockers) may be needed. It is important to distinguish PPT from Grave’s disease, as both can have TRAb antibodies but require different treatments. For low hormone levels, the condition is usually transient and may not need hormone replacement. However, if thyroid-stimulating hormone (TSH) levels are very high (TSH >20) or not recovering, thyroxine may be needed and could be required long-term for around 20% of PPT cases.
Preventive Measures
There is some evidence that selenium supplementation during pregnancy can decrease the risk of PPT in women who are anti-TPO positive. However, this should be recommended on an individual basis, as the benefits versus risks of routine supplementation are unclear.
Key Takeaway
New mums, don’t assume feeling terrible is always just due to poor sleep or the challenges of new baby life. If you have symptoms, see your GP for a check-up. 🧑🏼⚕️